Statins and cardiovascular disease outcomes: before and during the COVID-19 pandemic (SCOBAC): meta-analysis and systematic review of large populations

Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide, both due to heart and vascular disease. In Indonesia alone, 470,000 deaths are estimated each year due to CVD. Based on the latest guideline, statins are highly recommended in the prevention of CVD. Objective: To assess the role of statins in reducing CVD rates, and all-cause mortality, before and during the COVID-19 pandemic respectively. Methods: Literature search was performed from 1994 – 2021. Data extraction was in the form of Major Adverse Cardiac Events (MACEs) before the pandemic, and all-cause mortality, before and during the COVID-19 pandemic. Literature of medical database extracted based on inclusion and exclusion criteria. The research analyzed two study designs: clinical trials for pre-pandemic and observational studies for pandemics. Results: After critical appraisal, 23 clinical trials and 9 observational studies were included in the data analysis. Statins played a role in reducing MACEs before the pandemic (OR: 0.62, p < 0.05, 95% CI 0.60 – 0.74, I2 = 91%). However, there was no significance between the groups receiving statins and those without statins in reducing mortality during the pandemic (RR: 0.97, p > 0.05, 95% CI 0.90 – 1.04). Conclusion: Statins have been shown to statistically reduce mortality before the COVID-19 pandemic and further studies are needed during the pandemic. Government policies need to consider the lack of screening for dyslipidemia and appropriate statin treatment in the primary care setting, especially during the pandemic.